Indiana autopsy doctor talks about life, death and myths of the morgue

Emily Udell

IndyStar correspondent

If you’ve seen TV crime shows, you might picture autopsy doctors as socially awkward misanthropes dissecting human bodies in dingy corners of the county morgue.

Dr. Darin Wolfe wants to challenge that stereotype.

“We’re very friendly people and we want to help,” he said. “We just aren’t doctors who see patients in a clinic.”

Wolfe graduated from the Indiana University School of Medicine and completed a fellowship at the Marion County coroner’s office before becoming an independent forensic pathologist. He travels around the state conducting autopsies for county governments and private individuals on behalf of his Bloomington company, Indiana Forensic & Surgical Pathology. Sometimes his cases bring him into the courtroom as an expert witness.

“I love my job and I love going to work every day,” said Wolfe, who will be speaking at the Indiana Medical History Museum in Indianapolis on Nov. 1 as part of the museum’s forensic science lecture series.

His talk will cover the history of the autopsy, from the dawn of civilization through virtual autopsies, and speculate on the future of one of the world’s oldest medical procedures.

IndyStar spoke with Wolfe about the difference between hospital and forensic pathology, the everyday life of a pathologist and what pop culture gets right — and wrong — about his profession.

Question: How long does the typical autopsy take and how many do you perform in a day?

Answer: We do an external exam first. From starting the exam through the dissection, cutting the organs, submitting the tissues, the whole deal, it’s going to be a ballpark of two hours per autopsy. I did eight adults in one day in Fort Wayne about four weeks ago. That was my personal record. Most pathologists do not do eight autopsies in one day. A good average would be one to three. Past three, it’s getting a little crazy.

The National Association of Medical Examiners says forensic pathologists should do no more than 250 cases per year. The two-hour autopsy is not a standard, but it is thought the quicker you do an autopsy the more quality decreases.

Q: What do TV shows get wrong and right about performing autopsies?

A: Pop culture depictions are a bit sensationalized. Number one: The lighting is better (in reality). Number two: They (TV shows) always show someone eating a sandwich, drinking a coffee or smoking. You don’t have people eating in a morgue!

First, you do the external exam, identifying information such as hair color, eye color, race, age, that sort of thing. We look for signs of trauma and foul play. Then we do the internal exam in which we look at the organs of the head, neck, chest, abdomen and pelvis. We draw fluids like blood, urine and vitreous fluid from the eye for toxicology. For the most part, most pop culture depictions get the dissection portion right. It’s the environment around that (that they don’t).

Q: What about the stereotypes?

A: They always depict the pathologist as someone who is antisocial, who doesn’t communicate well, who is backward. That couldn’t be further from the truth. We’ve very friendly people and we want to help. We just aren’t doctors who see patients in a clinic.

At the hospital side of pathology, we’re giving correct diagnoses to doctors so they can take the next step in treatment. On the forensic side, there’s a family that can get some closure around why their loved one passed away. That’s the rewarding part of it. It’s not a butcher shop. I look at the autopsy like a surgical procedure. We just don’t need anesthesiologists for it.

Q: Can you describe a time when you found something surprising?

A: A couple of weeks ago, I did an autopsy on a guy who was found dead at 42 or 43 years old. There was no evidence of why he died. His toxicology was negative. I looked under the microscope at his heart and found a condition called amyloidosis. When you get amyloidosis in the area of the heart that produces the heartbeat, you can fall over dead. That’s a situation where I found an unknown, rare disease.

Twice this year, I have found people who have died of “probable drug overdose,” and guess what? They choked. They had meat in their larynxes. Literally, every day is a new mystery to solve. That’s the exciting thing about my job. You come in thinking one thing, but you cannot be sure until you do the complete exam.

Q: Why are fewer autopsies being performed these days?

A: There’s an asterisk there. The decline comes from the hospital side. One hundred years ago, almost everybody who died in a hospital got an autopsy. Then as our country started to make decisions about how we pay for health care, hospitals had a minimum (autopsy) requirement for quality control purposes. For a fair amount of years, it was 50 percent, and a hospital could bill for an autopsy and get paid. In the early 1970s, that practice was removed. If you can’t bill for a procedure, you’re not going to have your doctors do it unless absolutely clinically necessary.

Part B is the rise of technologies that can look into bodies without having to cut them — CT scans, MRIs, more advanced blood tests and all-around better delivery of medical testing. I wouldn’t say it’s become obsolete but definitely below 5 percent of all hospital deaths nationwide (result in an autopsy).

Forensics has not seen a decrease in autopsies (in part because) we’ve had a massive increase in the last 10 years in overdose deaths around the country. Pathologists are being inundated and there is a shortage of pathologists nationwide.

Q: In terms of hospital forensics, are we learning less about why people die or does technology fill the gap?

A: It is my belief and studies have shown that the autopsy can reveal a previously unknown “major diagnosis” in up to 40 percent of cases. How many things are being missed? I hate to be arrogant, but pathologists are the girls and guys in medicine who know the answer. We make the diagnosis so (we) know things are getting missed, even using the most sensitive technology. The only way to do it is to grab a scalpel and find it yourself and see it with your own eyes.